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ADDRESS <br />BUILDING PERMIT INFORMATION <br />% � � � � sr- <br />TYPE OF BUILDING <br />.5���"C.F �9�'�C Y <br />1) BUILDING PERMIT FEE <br />(A) PLAN CHECK FEE <br />2) <br />3) <br />WATER SERVICE TO BE PAID BEFORE BUILDING <br />PERMIT IS ISSUED �, <br />(A) TO BE DETERMINED BY PLBG. INSP. ,�GI INGH <br />(B) EXIST. WATER SERVICE, APPL. NO. <br />i� <br />(C) LOCATION L�' C� Z L� n�T�� ��" �fY `�= �', <br />Li»I��(U�/ % S So O� �6 �%�- CHART �lJ- `� c� � <br />DRIVEWAY PERMIT TO BE PAID BEFORE BUILDING <br />PERMIT IS ISS�JED �_ FT. AS/� /IL% _D/�^' (TYPE) <br />TOTAL'�° <br />4) STATUS OF SEWER CI-LARGES: FOOTAGE <br />BOND DISTRICT N, S, E, W. <br />LA]JDSCAPE NOTES <br />SEWER CONNECTION GHARGES: <br />TRUNK <br />LATERAL <br />TOTAL CONNECTION CHARGE <br />SEWER PERMIT FF.E <br />CATCH BASIN PERMIT FEE <br />TOTAL SEWER PERMIT FEF.S <br />5) NONTHLI SE�VER CHARGES: <br />SEWER CONSTRUCTION: <br />SEWER SERVICE: <br />DATE I�'r-� 7'� <br />$ � �� - <br />$ 5 %- G�_ n <br />� /��<,<��i <br />� 7�S`O <br />�2 �i ` sd <br />,� r <br />c, <br />. <br />$ <br />$ <br />$ — <br />TRUNK $, <br />LATERAi � <br />$ <br />LOCATION OF SIDE SEWER OR T�E IN THE MAIN: CHART <br />� <br />c/. . i rn n/n — n.i�,Q.//_A/jG� —_S<'F . <br />INFO COMPILED BY: <br />REVIEW: <br />APPROVAL: <br />ENGINEERING DEPARTMENT <br />=��This total must be paid before building permit is issued. <br />� �. <br />DATr:1«-- r-iy <br />DA T E /..Z ���y i�" <br />DAT <br />